remicade & insurance

[lt_333]

I have been on enbrel for 6 months...fading a bit for the PA but has only helped the severe P a bit.

I talked with my RA who said she would try for remicade. But my insurance rejected it...i guess only enbrel is approved for PA. I know there is an advocate to call at NPF but wondering how/if anyone else got remicade approved? And did it also work on the P?

thx

[web63]

You can get it. Your Rheumy will have to tell them you have RA.
I don't understand why you did Enbrel before Remicade.
Anyway, why not just try Humira?
Remicade is a pain in the rearend. You have to go where ever to get the 3 to 4 hour infusion.
Good Luck,
Thanks,

[Rado]

Hi there,

I disagree with the statement bellow, regarding Remicade being pain in the butt. If you don't get any reactions to your infusion, they can and likely will speed up the infusions. Mine lasted no longer than 2 hours, and watching a video or reading a mag or do some work is not total waste of time. Anyway, that is somewhat besides the point, as no drug that works (and Remicade does work beautifully for some people) is pain in the butt.

I was on Remicade for over 2 years and it worked like a magic, and just last week swtiched to Humira, because I no longer respond as well as I used to. Truth be told, I still can go back on Remicade and enjoy fairly effective results. As far as P, I haven't had a patch of it eversince my first dose of Enbrel in 1999.

On the other hand, however, web63 is right. Your doctor should have written Rheumatoid Arthritis code instead of PA. It's called off-label prescription and its widely accepted practice. I am afraid, now that your insurance company knows that PA is correct diagnoses, that they will decline it. Its worth the try though, tell them it was a mistake. Same goes for Humira (not approved for PA yet). It will happen withing next year or so, as they both are in clinical trials for PA. Hope this helps.

[lt_333]

Yeah...i think their assistant made the mistake & now I am going to pay for it...literally.

Remicade has a support system that if you don't have good health coverage and $$$, they can get centocor to try to approve for free but i do have good health coverage.

NPF said they would write a letter for me to try to help. I am going tomorrow to the doc. to seek some assistance. Enbrel has helped my PA, fades every now & then but gave me my life back for the last 6 months...doesnt do much with the P.

I don't think i would mind every 6-8 weeks sitting and reading for 2 hours rather than poking myself 2x week. Perhaps I will have toup my enbrel dosage to 50mg/2x if no remi. thanks

[stormechaser]

I applied to Needy Meds. Then, I was assigned a rep at Centocor. The whole process took about 2 1/2 months, but it was well worth it.
My rheum told me it was Enbrel, then Remicdade. I was too advanced to even think about Enbrel, however, I may toy with it in a year or so as you can go off MTX when on Enbrel and take it thru pregnancy (I would like to get pg in a year or so).
So, to me at this stage, the two hour infusion is totally worth it.
Centocor said that you have to meet certain criteria and one of them is no insurance OR insurance that doesn't cover Remicade.
Go to:
www.needymeds.com
Look up remicade and you will get all the info you need. They have hundreds of drugs on their besides Remicade including Enbrel. Good luck!!!!!


P.S.--I have only had my first of three infusions so far with the 2nd on 7/21/03 and the 3rd in August. I have felt a marked improvement in my PA since the next day after infusion. However, it has only been the last two days or so that I have noticed my skin clearing up. I on purpose did not use anything but moisturizer to see what remicade could do.

[kjh130]

FWIW - My rheumatologist was able to get my insurance company to agree to cover the Remicade for my PA. It took several months, and several letters back and forth, but it was finally Ok'd almost two years ago. I started on the drug in November of 2001.

So far, for me, it's been nothing short of a miracle from the first week, both for my P and my PA. It's like I no longer have either. I did have one PA flare up last winter, which was brought on by an extremely stressful situation I was dealing with, but my doctor increased the dosage and moved me from every eight weeks to every six, and thing went back to "normal" right away.

However, I do know, from others who have received treatments with me, that it seems to do nothing for some folks. I've been extemely lucky with it - no side effects either.

Ironic thing was that at least a year earlier, my dermatologist had put me on CellCept, a drug for organ transplant patients (and, no, I have never had an organ transplant), and the same insurance company didn't blink at covering it. But of course, it doesn't cost anywhere in the nieghborhood of Remicade.

Sort of puts a different face on the "it isn't approved for that condition" story the insurance companies use to deny coverage.

My history - P since 1973, PA since 1986. Tried everything up to and including UVB and Methotrexate. Always did some good, but never cleared either up that well.

I just cross my fingers that it continues to work for me. I don't think I ever thought I would feel as good as I do, both physically and mentally.

Kevin